APPLICANT'S ABSTRACT: I developed an interest in alcoholism prevention during my residency in Primary Care Internal Medicine at UCSF. Since then, I have focused my education and research on the development and evaluation of screening methods for at-risk drinking. My career goal is to perform trials evaluating the effectiveness of primary care interventions for at-risk drinking. Such trials will require measures of patient-provider communication, analyses over time that account for clustering of patients by providers and/or clinics, and economic analyses. I would use a K23 award to study and obtain experience in three disparate disciplines: patient-provider communication, advanced epidemiology, and health economics. If awarded a K23, I would have two Sponsors: Stephan Fihn, MD, MPH, Division Head, General Internal Medicine at University of Washington (UW), and Susan Curry, PhD, Professor of Health Services at UW. Five UW faculty and an outside consultant, as well as UW's outstanding School of Public Health, would also support my work. The main objective of my research would be to determine the effectiveness of a population-based alcohol-screening program. Initially, I would use ethnographic analysis of audiotapes of at-risk drinkers' primary care appointments and interviews with providers, to explore barriers to primary care alcohol counseling. Then, using data from a prospective, multi-center, randomized trial of over 20,000 primary care patients, I would evaluate the effect of a mailed, population-based, alcohol screening program on primary care alcohol- related discussions, rates of at-risk drinking and alcohol-related health outcomes at one and two years follow-up. Finally, I intend to estimate and analyze costs, and the cost- effectiveness, of a mailed, alcohol screening program.